Invasive fungal infections are a growing problem in critically ill patients and are associated with increased morbidity and mortality. Complex medical and surgical problems, disruption of natural barriers, multiple invasive procedures and prolonged antibiotic treatment are some of the factors contributing to the alarming increase of fungal infections in the Intensive Care Unit (ICU) setting. In terms of occurrence rates, the most important fungal infections are invasive candidiasis (IC) and invasive pulmonary aspergillosis (IPA). Invasive candidiasis in ICU patients includes mainly candidemia, primary or catheter-related, and intra-abdominal candidiasis. Candida bloodstream infections occur at highest rates in the ICU population, with this setting accounting for 33–55% of all candidemias. The epidemiology of Candida infections is not constant.

Prehospital emergency medical services (PEMS) are becoming more and more sophisticated as more point-of–care advanced medical technology is available in the field. Yet, the literature around the subject is limited, as data come mainly from Northern Europe, USA, Canada and New Zealand. The aim of this analysiswas to describe time trends of PEMS activity in a region of northern Greece.Use of data retrospectively collected for PEMS usage, in the regional unit of Thessaloniki, Northern Greece from 2006 to 2015. The area of interest represents a little more than 10% of the total population of Greece.Total utilization of PEMS shows an overall l4.03% decrease over the decade; yet with an increase in the 2 last years.The mean rate of use was 69/1000 inhabitants for ambulance services and 1.5/1000 for medical interventions (MICU).

Amiodarone-induced thyrotoxicosis is a rare but serious complication of amiodarone use, especially in patients with severe cardiac disease. We discuss the anaesthetic considerations and management of patients with severe cardiac disease who require lifesaving thyroidectomy. We present a patient who developed amiodarone-induced thyrotoxicosis, following administration of amiodarone and hepatotoxicity due to thiamazole. Patient’s life depended upon surgery as soon as possible. Total thyroidectomy was performed under general anaesthesia with precautions related to hyperthyroidism and cardiac stability. Complete cardiac rehabilitation was achieved two weeks after surgery. Total thyroidectomy is, in selected cases, the only treatment option and should not be delayed based on the hypothesis that pre-operative medical preparation will optimize the patient’s condition (endocrine and cardiac).

Placenta previais anobstetriccomplication in which theplacentais inserted partially or wholly in the lower uterine segment. It is a leading cause ofantepartum haemorrhage. We report a case of 31-year-old woman presented in Obstetric and Gynecological clinic with signs and symptoms of Placenta previa. One day after admission, patient gave birth by caesarean section to a healthy baby. Yet, two hours later, the patient's condition was deteriorated due to postpartum hemorrhage (PPH). The diagnosis of Placenta previa was based on symptoms and sign as continuous bleeding ‘ex utero’, clots in vagina, uterine atony and distended bladder. Blood loss was approximately >1000 ml and was accompanied by clinically apparent shock. Using a conservative treatment such as the application of uterotonic drugs and uterine massage, we managed uterus to be saved.

From 2004, the presence of the Greek e-Journal of Perioperative Medicine among the National Scientific Journals has been gradually increased. On behalf of the editorial board of the Greek e-journal of the Perioperative Medicine, we would like to thank you for your support in order to reform and modernize our journal.

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After the implementation of Common Assessment Framework (CAF) – a useful quality tool – in the ICU of General Hospital of Trikala from 2012 up to 2015, we integrated the first cycle of self assessment and we present our results and conclusions of the past 3-year-period (2012- 2013 -2014). We analyzed CAF, FS- ICU 24, TISS-28 and Burn out syndrome questionnaires and medical indicators as Standardized mortality rate (SMR), Length of Stay (LOS), Standardized Resource Use (SRU), SMR/SRU, Therapeutic intervention scoring system (TISS-28), TISS-28/days of hospitalization, Nurse/Patient ratio, cost indicators and mortality. Analyzing the CAF questionnaire the score was 2.5-3.5, counting the indicator TISS-28 we found an average value higher than 50, concerning the burn-out syndrome questionnaire it was found that 58.82% of the respondent employees working in the ICU had mild symptoms of the syndrome. We analyzed the true Level of ICU (TISS-28/days of hospitalization) with the Level of ICU (nurse /patient ratio) and we found that they were not alike. We found an increase of mortality rate and LOS (length of stay) during the period of 2011 –2015 but a gradual reduction of the SMR/SRU indicator (the whole period ≤ 1) and a decline of the average cost/ patient and the average cost/ day of hospitalization.